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Indianapolis Association
of Black Journalists
P.O. Box 441795
Indianapolis, IN 46244
Phone: (317) 925-2702
Fax: (317) 925-6624

INDIANAPOLIS ASSOCIATION OF BLACK JOURNALISTS (IABJ)
2004-05 MEMBERSHIP APPLICATION

Type of Membership (Check One):

 

Professional

 

Student

Membership Date:

 
           

PROFESSIONAL MEMBERSHIP INFORMATION

NAME:

 

BIRTHDATE (Year Optional):

 
     

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ADDRESS:

 

 

 

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FAX:

 

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WORK

JOB TITLE:

 

COMPANY:

 

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CITY:

 

 

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Preferred Mailing Address (Check One):

 

Home

 

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Preferred E-Mail Address (Check One):

 

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Work

 

OCCUPATION (Check One)

 

 

Advertising

 

 

Marketing

 

 

Public Relations

 

 

Television

 

 

 

 

 

 

 

 

 

 

 

 

Internet

 

 

Print

 

 

Radio

 

 

Other (Specify below)

If other, specify:

 

 

 

STUDENT MEMBERSHIP INFORMATION

COLLEGE/UNIVERSITY:

 

MAJOR:

 

 

CLASSIFICATION:

 
           

 

 

MEMBERSHIP DUES (Make checks payable to IABJ)

 

$35         Professional (Expires August 31, 2005)

 

Mail to:

IABJ

c/o 2004-05 Membership Dues

P.O. Box 441795

Indianapolis, IN 46244-1795

 

$15         Student (Expires August 31, 2005)

 

 

  

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Indianapolis, IN Chapter